Jump to full article: MedPage Today, 2010-08-31
Author: George Lundberg, MD, Editor-at-Large, MedPage Today
Intro: Patients and physicians must and do screen. The issue is cautious appropriateness. Self-screening by patients is easy, free, and fundamentally harmless. Look at your skin for potential melanomas, be alert to warning symptoms of a stroke, learn the early signs of alcohol dependence, observe your urine for gross blood.
These are observations that have almost no downsides and could trigger life saving interventions. But when the American Medical Marketing Machine (AMMM) starts screening campaigns, watch out. Both the well intended zeal of the advocacy groups and the ambitious avarice of the suppliers and providers can wreak real havoc, especially when they combine forces.
Is the benefit to individuals or the public going to be worth the harm to individuals and the costs to whomsoever pays the bills? Case in point: lung cancer.
The number one cancer killer in America. A really big deal. Caught late; usually kills; caught early; also often kills. How could even earlier change that equation? What are the downsides to screening for it? . . .
Good things can happen after screening. But so can bad. A false positive means you found something that was not there; a false negative means something was there and you did not find it; a misidentification means you found something that was there but you called it the wrong thing.
Those are all bad. It is a little like in football; you throw a forward pass; three things can happen, but two of them are bad.
So, sure, screen; but remember Hippocrates. First, do no harm.
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